Arthroscopy Of The Shoulder

What To Expect After Shoulder Arthroscopy

In most cases, you will be able to return home on the day of the procedure. You will need a companion to drive you home, particularly if general anesthesia has been used. In some cases, an overnight hospital stay will be required.

• Incision care. The portal incisions are so small that they are not always closed with sutures. This will depend on the preference of the surgeon. Dressings are usually light and are kept on for a couple of days. Dressings and wounds should be kept clean and dry. Often, some drainage occurs from the wounds during the first day. This drainage is from the fluid used during the surgery. It is usually light and stops within the first 24 hours.
• Shoulder immobility. The amount of movement allowed following surgery will depend on the procedure that was done. Your doctor will give you very careful instructions about this. Following rotator cuff repair and repair of an unstable shoulder, certain shoulder movements are not allowed for a period of time. Your shoulder will be held in a sling, a sling and swath, or a brace following the surgery.
• Ice. Most doctors will recommend that ice be applied to the shoulder to control pain and swelling. Excessive swelling increases pain and may increase scarring, which in turn will tend to cause stiffness in the joint. You should apply ice for at least 20 minutes about three times a day. Ice should not be placed directly onto the skin. Place a moist towel on the skin and apply ice in a plastic bag directly over the towel.
• Medication will be prescribed for pain. This medication will usually be in the form of pills, but in some cases, when a one or two day hospital stay is required, a patient-controlled anesthesia (PCA) pump will be used. This pump provides pain medication at the push of a button that is connected to a dispensing machine. An intravenous catheter will be left in your arm to allow the medication to enter your bloodstream. PCA is usually continued for one or two days. The total amount of medication dispensed is carefully regulated so you cannot “overdose”.

Before you leave the hospital, you should have scheduled a visit to see the doctor within one to two weeks of the operation to assure that your wounds are healing properly and all is going well. A visit at approximately three to four weeks will serve to assure progress in therapy. Follow-up visits will then be scheduled at about six weeks and at three and six months. The doctor may obtain new x-rays of the joint at several of these visits.

Physical Therapy

Depending on the procedure performed, the doctor may recommend a course of physical therapy to begin immediately after the operation. A series of specific exercises will be prescribed, to be done under the direction of a rehabilitation specialist.

Rehabilitation is often the most important part of treatment. Chances of a full recovery increase when the exercises are done faithfully.

Some surgical procedures may require that limitations be placed on shoulder motion. In most cases, however, movement should begin early.

• The pendulum is an exercise often prescribed immediately after the arthroscopic procedure. It is done by leaning sideways and allowing the arm to swing in small circles. This pendulum motion will increase range of motion in the shoulder joint and decrease stiffness.
• Isometric exercises are exercises in which the muscles are tightened without actually moving the joint. Depending on the procedure, these may be prescribed in the first week or two after the arthroscopic surgery.
• Passive range of motion exercises are exercises in which someone else moves your shoulder, usually the physical therapist, or you use your other arm to move the side you were operated on. These exercises increase the mobility of the shoulder joint without stressing any of the repaired tissues. Depending on the procedure, these exercises may be started within a few weeks after the arthroscopic surgery.
• Resistance exercises are exercises in which the shoulder is moved against resistance, usually starting with elastic tubing and progressing to light hand-held weights. They are usually begun at about four to six weeks.